腹腔镜手术对胆囊结石合并急性胆囊炎患者血清T淋巴细胞亚群、应激及免疫功能指标的影响

Effect of Laparoscopic Surgery on Serum T Lymphocyte Subsets, Stress and Immune Function in Patients with Cholecystolithiasis and Acute Cholecystitis

目的:探讨腹腔镜手术对胆囊结石合并急性胆囊炎患者血清T淋巴细胞亚群、应激及免疫功能指标的影响。方法:选取本院2018年12月-2020年12月临床收治的胆囊结石合并急性胆囊炎患者80例为研究对象,随机将患者分成研究组和对照组,每组40例。研究组患者给予腹腔镜手术,对照组患者给予传统开腹手术。对两组患者的应激状态指标[白介素-6(IL-6)、C反应蛋白(CRP)、血清皮质醇、促肾上腺皮质激素(ACTH)]、血清T淋巴细胞亚群指标(CD3、CD4、CD8、CD4/CD8)、免疫球蛋白指标(IgA、IgM、IgG)、手术情况指标(手术时间、术中出血量、切口长度、下床活动时间)进行观察和比较。结果:术前两组患者的各项应激指标、各项血清T淋巴细胞亚群指标和各项免疫球蛋白指标水平差异无统计学意义(P>0.05)。术后1 d和术后3 d,对照组的IL-6、CRP、血清皮质醇水平、ACTH均高于研究组,IgA、IgM、IgG及CD3、CD4、CD8、CD4/CD8水平均低于研究组(P<0.05)。研究组患者的手术时间长于对照组,术中出血量少于对照组,切口长度短于对照组,下床活动时间早于对照组(P<0.05)。结论:给予胆囊结石合并急性胆囊炎患者腹腔镜手术,能够有效地降低患者应激反应状态,改善患者T淋巴细胞亚群和免疫功能指标,促进患者术后尽快康复。

Objective:To investigate the effect of laparoscopic surgery on serum T lymphocyte subsets,stress and immune function in patients with cholecystolithiasis and acute cholecystitis.Method:From December 2018 to December 2020,a total of 80 patients with cholecystolithiasis complicated with acute cholecystitis in our hospital were selected as the research objects,and they were randomly divided into study group and control group,40 cases in each group.The study group was treated with laparoscopic surgery,while the control group was treated with traditional open surgery.The stress state index[interleukin-6 (IL-6),C-reactive protein (CRP),serum cortisol,adrenocorticotropic hormone (ACTH)],serum T lymphocyte subsets indexes (CD3,CD4,CD8,CD4/CD8),immunoglobulin index (IgA,IgM,IgG),operation status indexes (operation time,intraoperative blood loss,incision length and ambulation time) of the two groups were observed and compared.Result:There were no significant differences in the stress indexes,serum T lymphocyte subsets and immunoglobulin indexes between the two groups before surgery (P>0.05).1 and 3 days after surgery,the levels of IL-6,CRP,serum cortisol and ACTH in the control group were higher than those in the study group,while the levels of IgA,IgM,IgG and CD3,CD4,CD8 and CD4/CD8 were lower than those in the study group (P<0.05).The operation time of patients in the study group was longer than that in the control group,the intraoperative blood loss was less than that in the control group,the incision length was shorter,and the ambulation time was earlier than that in the control group (P<0.05).Conclusion:Laparoscopic surgery for cholecystolithiasis complicated with acute cholecystitis can effectively reduce the stress reaction state of patients,improve the T lymphocyte subsets and immune function indexes of patients,and promote the recovery of patients as soon as possible.